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Multimodality Diagnosis of Mesenteric Ischemia
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Open Mesenteric Interventions Are Equally Safe as Endovascular Interventions and Offer Better Midterm Patency for

Shipra Arya1, Stephanie Kingman2, Jordan P Knepper3

  • 1Division of Vascular Surgery, Emory University, Atlanta, GA; Surgical Service Line, Atlanta Veterans Affairs Medical Center, Decatur, GA.

Annals of Vascular Surgery
|November 7, 2015
PubMed
Abstract

Insights

Endovascular and open mesenteric interventions show similar safety for acute and chronic mesenteric ischemia. However, open revascularization offers better midterm patency for chronic mesenteric ischemia.

Area of Science:

  • Vascular Surgery
  • Interventional Radiology

Background:

  • Endovascular (EV) techniques are increasingly favored for mesenteric interventions due to perceived safety.
  • Concerns exist regarding the midterm and long-term efficacy of EV compared to open surgical approaches.
  • This study compares institutional outcomes of EV and open techniques for mesenteric ischemia.

Purpose of the Study:

  • To compare the safety and efficacy of endovascular (EV) versus open revascularization for acute (AMI) and chronic mesenteric ischemia (CMI).
  • To evaluate perioperative outcomes, complications, and long-term patency rates for both treatment modalities.

Main Methods:

  • Retrospective analysis of medical records from 2002-2012 at a single institution.
  • Inclusion of patients who underwent either open or EV mesenteric procedures.
  • Extraction and analysis of demographic, perioperative, and follow-up data.

Main Results:

  • 38 patients underwent EV interventions, and 77 underwent open revascularization; demographic and perioperative characteristics were similar.
  • No significant differences in postoperative complications, 30-day morbidity, or mortality were observed between EV and open groups for AMI or CMI.
  • While 30-day mortality for AMI was comparable (EV 45.5% vs. open 34.8%), no mortality occurred in CMI patients.
  • Mean follow-up was longer for open procedures (34.9 vs. 12.7 months).
  • Primary and secondary patency rates were superior for open revascularization in CMI patients.

Conclusions:

  • Open revascularization is as safe as EV interventions for both acute and chronic mesenteric ischemia.
  • Open revascularization demonstrates superior midterm patency rates compared to EV procedures for chronic mesenteric ischemia.

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